Nitrous Oxide Administration (81)
Indications (PB&K):
1. Pain from musculoskeletal trauma
2. Non-respiratory burn
3. Kidney stones
Rules:
1. 50/50 with oxygen
2. Monitor pulse ox
3. Self administered by patient
4. NO contraindications
Contraindications:
1. ALOC
2. Shock
3. Severe facial injuries
4. COPD
5. Abdominal trauma
6. Distended abdomen
7. Head injury
8. Pregnant
9. Fire hazard situation
External Jugular Vein Cannulation (82)
- Trendelenburg position
- Turn head away
- IV at 30 degrees
- Secure
Decompression of Tension Pneumothorax (83)
- Oxygen high flow
- Identify the side that needs decompression (decreased breath sounds)
- Clean site
- Introduce the needle into the 2nd intercostal space, directing it perpendicularly over the
superior aspect of the 3rd rib or 4th intercostal space mid axillary line - Insert needle (14g, 1.5in of length) until rush of air sounds
- Remove needle and leave in catheter
- Secure
- Reassess breath sounds
Medication Assisted Intubation (84)
Indications:
1. GCS <8
2. Imminent respiratory arrest
3. Imminent tracheal closure
4. Sever chest flail or severe open chest wound with cyanosis and RR >30 or <10
Adult:
1. Versed 5mg IV/IO/IM/IN increments until sedation
-max 10
-2.5mg Versed to maintain sedation
or
Ketamine: 2mg/kg IV/IO/IM/IN
-may repeat x1
Peds:
1. Versed .1mg/kg slow IV/IO q 2 minutes
-max of 5mg
-.15mg/kg if IM
or
Ketamine: 2mg/kg IV/IO/IM/IN
may repeat x1
-Versed .1mg/kg to maintain sedation
Adult Airway (85)
ET–BVM–Supraglotic–cric
Able to intubate with ET tube?
Yes= Intubate
No= Able to ventilate with BVM?
Yes=BVM
No= Insert supraglottic device
Able to ventilate with supraglotic device?
Yes= Ventilate
No= Perform needle cric
Transport
Needle Cricothyrotomy (86)
- Attach an empty syringe to a large gauge (14)
- Locate site and cleanse
- Puncture cricoid membrane at a 45 degree angle (The plunger of syringe will move freely when the needle has entered the trachea)
- Remove needle and advance catheter into the trachea
- reattach syringe and attach the plastic adapter from a #3 ET tube and ventilate
- Ventilate with 2-3 seconds of inspiration and passive exhalation
Transcutaneous Cardiac Pacing (87)
Notes
70bpm
Concealed Carry/Firearm (88)
- Avoid having to transport the weapon
-If immediate transportation needed, do not delay
-If patient is stable, may delay until law enforcement arrives
Refusal of Care
- Begin Eval
Once patient refuses - Are they
-Altered mental status?
-Altered decision making capacity?
-Age<18?
Yes= Deny refusal
No= - Document situation in all cases of refusal and contact medical control
-Narrative must include:
–evidence of decision making capacity (A&Ox4)
–potential consequences
–alternative care
–signature of patient (If they refuse to sign, document the situation)
–Try to get witness signature
